E-drug: ARV access
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[Two articles on ARV access in the most recent BMJ. Copied as fair
use. HH]
BMJ 2001;322:629-630 (17 March 2001)
Editorials
Poor world health and rich world wealth
Commercial companies alone can't solve the health problems of
developing countries
Oxfam and allied aid organisations have recently accused the
international pharmaceutical industry of using its influence to maintain
a worldwide system of intellectual property law and enforcement that
is now denying the world's poor access to essential medicines and
blocking progress towards health for all.1 Enabling all sections of the
global population to gain the extended life expectancy enjoyed in
developed countries is one of the world's fundamental challenges.2
But it is not clear that doing away with legitimate intellectual property
rights will aid this process in the long term, or that individual
companies can carry a responsibility that properly belongs to
governments and peoples.
The concern of Oxfam and others has been made acute by the
HIV-AIDS pandemic in regions where the price of patent protected
antiretroviral drugs and drugs for opportunistic infections makes them
unaffordable to all but a privileged few. Health gains made in previous
decades are being lost. The pharmaceutical industry's critics also
blame it for inadequate research investment in diseases relevant to the
health of the world's poor. Oxfam's report Dare to Lead urges the
newly formed Anglo-US company GlaxoSmithKline to play a central
role in reforming this situation.3 It argues that GlaxoSmithKline has a
moral duty "to forgo [intellectual property] privileges in developing
countries, if [these] are likely to lead to an increase in prices" and
should donate to an international research fund controlled by the
World Health Organization. Oxfam criticises current industry
programmes to give low cost and free medicines to developing
countries for being too small scale and perpetuating the system of
intellectual property protection enshrined in the World Trade
Organisation's current rules (the trade related aspects of property
rights (TRIPS) agreement).
Those defending the industry's position on issues such as the supply
of generic versions of patented AIDS treatments in South Africa and
Brazil4 argue that intellectual property law exists to generate global
public benefits. They emphasise that intellectual property legislation
and the TRIPS agreement were created to defend the interests of the
entire world community in continuing investment in research and
innovation.5 Most economists would accept that intellectual property
needs protecting in market economies. Without patents, medicines
such as today's AIDS treatments would not have been developed by
privately financed organisations. However, it is also true that in the
immediate future rich world citizens have more to gain from
intellectual property protection than those of the poorest nations. The
important issue is to find ways of providing very poor populations with
cheap access to patented essential medicines in ways that do not
permit "leak back" sales of such products to richer countries and so
undermine research for the future.
Suggestions that pharmaceutical company managers responsible for
protecting pension fund and other shareholder interests should invest
in areas likely to yield low returns are also questionable economically.
It would be more logical to argue that if medicines like antiretrovirals
can, if supplied free or at marginal cost, contribute to the control of
AIDS in areas such as sub-Saharan Africa6 then governments and
electorates of the rich world (who are key stakeholders in the modern
pharmaceutical industry) share a common moral responsibility to meet
their price.
Some campaigners may have despaired of winning support for this
good cause through direct appeals to the voting public and leaders of
North America, Europe, and Japan. Attacks on relatively enlightened
companies such as GlaxoSmithKline may be seen as a tactic designed
to achieve by threat what cannot be gained by calls for compassion
and international solidarity. One danger is that this could help to
reinforce a blame oriented global political culture which has little
underlying respect for truth or genuine humanitarian values.
It could also needlessly harm pharmaceutical companies, which are
valuable national and international assets and have played a vital part
in creating the medicines at the centre of the current debate.
However, to the extent that Oxfam's latest intervention will help to
promote more committed approaches to improving poor world health it
is welcome. All sides in what might otherwise prove to be merely
another phase of a sterile, decades long7 debate need to accept that
the way forward demands mutual respect and a pragmatic willingness
to work together for better world health.
GlaxoSmithKline publicly reacted to Oxfam's criticisms by accepting a
responsibility to do more to improve the supply of medicines to the
poor world.8 It is also encouraging that Britain's chancellor of the
exchequer announced in last week's budget the introduction of tax
credits to encourage UK based pharmaceutical research into diseases
prevalent in developing countries. This measure, which stems in part
from the work of the prime minister's task force on the pharmaceutical
sector, is an important step. The chancellor also repeated his support
for the creation of a new international fund for purchasing drugs and
vaccines for the world's most vulnerable children and adults.
No commercial company can act as a charity without running the risk
that it would soon have no more than good intentions to offer either
its customers or its owners. But if policymakers can create purchasing
funds, ensure that patented medicines supplied at low cost to poor
populations do not "leak back" to rich world markets, and restrain
medicine price negotiators in prosperous countries from demanding
savings to match those offered to the poorest, progress could and
should be made. Given appropriate incentives, the profit motivated
pharmaceutical industry provides a powerful force for improving both
public health and private wealth throughout the global community.
David Taylor
Professor of pharmaceutical and public health policy
School of Pharmacy, University of London, London WC1N 1AX
Acknowledgments
DT worked with the Office for Health Economics (funded by the
pharmaceutical industry) and the Association of the British
Pharmaceutical Industry in the 1980s. He has received consultancy
fees from several pharmaceutical companies in the past five years,
though none related to the subject of this editorial. He acted as a
consultant to Unicef in 2000.
1. Oxfam. Drug industry price life saving medicines beyond reach of
the poor [press release 12/02/01]. Oxford: Oxfam, 2001.
2. Macfarlane S, Racelis M, Muli-Musiime F. Public health in
developing countries. Lancet 2000; 356: 841-846[Medline].
3. Oxfam. Dare to Lead: public health and company wealth. Oxfam
briefing paper on GlaxoSmithKline. Oxford: Oxfam, 2001.
4. Yamey G. US trade action threatens Brazilian AIDS programme.
BMJ 2001; 22: 383[Full Text].
5. Sykes RB. New medicines, the practice of medicine, and public
policy. London: Nuffield Trust, 2000.
6. Zwi K, Soderlund N, Schneider H. Cheaper retrovirals to treat AIDS
in South Africa. BMJ 2000; 320: 1551-1552[Full Text].
7. Taylor DG. Medicines, health and the poor world. London: Office
of Health Economics, 1982.
8. Garnier J-P. Drug giants aren't the problem. Guardian 2001; 14
Feb.
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BMJ 2001;322:635 (17 March 2001)
News
South African court battle damages drug industry's image
Pat Sidley, Johannesburg
The Pharmaceutical Manufacturers Association and 39 of its members
have lost one crucial battle inside Pretoria's High Court and a larger
one outside. The industry's image has suffered irreparable damage
from the case and has been portrayed as putting profits before lives in
the country.
The multinational pharmaceutical companies are fighting the South
African government's Medicines Control Act, passed in 1997. They
want to stop the government adopting various measures to lower the
price of drugs in the country.
The pharmaceutical manufacturers had tried in thousands of pages of
legal argument to confine the court battle to one of technical legal
wording, much of this around the clause that would have allowed for
parallel importing of drugs. But the judge allowed a late application by
an AIDS activist group to participate in the trial.
This move, and the pressure internationally from human rights groups,
has refocused the trial on the issue of making drugs for HIV and AIDS
affordable to millions of South Africans who face an early death from
AIDS related causes.
The Treatment Action Campaign, which lobbies for cheaper access to
drugs for people living with HIV and AIDS, applied to be treated as a
"friend of the court" (amicus curia). Its application was vigorously
opposed by the drug companies, which claim that they are defending
their constitutional rights and the rule of law.
The judge, however, accepted the argument that the action group
brought a special dimension to the trial and made it clear he believed
that issues around affordability of drugs for the HIV/AIDS crisis was
one which needed urgent treatment.
The trial was postponed to mid-April so that the Pharmaceutical
Manufacturers Association can reply to the action campaign's
argument.
As the court case began unfolding, moves to reduce the costs of AIDS
drugs were taking place outside the court arena. Cipla, an Indian
company that produces cheap generic drugs, decided that it would
use South Africa's patent laws to apply for a compulsory licence to
supply generic antiretrovirals to South Africa. And Merck, one of the
pharmaceutical companies involved in the UNAIDS (the joint UN
programme on HIV/AIDS) access initiative, which is also involved in
the court case, offered to drop the prices substantially on two of its
antiretrovirals.
Cipla's move puts the spotlight on the South African government,
which has recently been enjoying the effects of the good public
relations activities of the activist groups. Its views on HIV/AIDS and
medicines, however, are not clear after a year of "denial," during
which President Thabo Mbeki questioned whether HIV caused AIDS.
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